August 3, 2010

One more turning point in the demise of low fat diets came this week. The Annals of Internal Medicine released the results of a two-year study examining the comparative effectiveness of a low carbohydrate diet in direct comparison to a low fat diet. Unlike many other studies, this one was comparatively long-term (two years) and explicitly factored ‘in’ education and lifestyle changes (counseling and exercise).

My buddy Jimmy Moore on the Livin’ la Vida Low Carb blog has a great breakdown of the study (he really dug deep and included lots of references), so I won’t do an exhaustive recap here, but will include a few of the highlights:

For my part, it’s another in what I expect to be many more data points on the path to the demise of the entire low fat premise. I’ve read a number of articles about this study and remain surprised to find that the non-calorie-restricted element of the low carb diet is not emphasized more (even among those who would be inclined to point this out). Maybe it’s so well understood that many don’t think it bears repeating, but I do. This study compared one ‘diet’ that essentially asks you to be HUNGRY basically ALL THE TIME to a diet that says ‘each as much as you want until you’re sated – then stop.’ It just boggles my mind that this distinction continues to receive so little emphasis. Which one of of those two options are you likely to continue doing over a lifetime? For my part, I don’t like being hungry if I have a choice. This is the main reason why I’m convinced low fat diets will begin to wane as we come out of this phase of dietary orthodoxy. Why starve if you can accomplish the same ends via other means.

One more thing, while I’m at it. It’s not so much about this particular study, but about the metrics used for diet studies all together. As I write this, my body fat is down to about 12%, I have a 32-inch waist. Solely based on BMI calculations, I’m bordering on obese. What’s the point? The point is weight, while relevant, is not the most relevant factor to be measured. The very most important factor is abdominal (omental) fat. Failing the ability to directly measure abdominal fat, tracking overall body fat has to be a better factor to track than weight. Why are there no studies that track *fat loss* between competing diet regimens. Is it really that hard?! Would you care if you cut you body fat percentage by a 1/4 but remained at the same weight? Seems so simple, I must be missing something.

May 19, 2010

You remember the craze, don’t you. Back in 2003 and 2004 it was all Atkins, all the time. TV shows, packaged products lining grocery store aisles. Phenomenal stories of quick weight loss.

Then, like every other fad, it seemed to fade away. Products disappeared from store shelves, negative stories started popping up in the press and grave warnings from people who supposedly know better than you.

So, why on earth would there be anything truly new about the Atkins diet that would be worth noting? Well, let’s find out.

One more benefit from having attended last month’s ASBP conference in Seattle was the opportunity to meet two of the authors of this book. In speaking with Dr. Westman, I noted several of my colleagues at work had been probing to see how we could organize our efforts to increase the awareness of the benefits of carbohydrate restricted diets (and high-intensity strength training) towards the end of enabling weight loss and addressing metabolic syndrome and diabetes. Our benchmark for comparison was the very successful 20/20 Lifestyles program which was developed at the Pro Sports Club in Bellevue Washington. Without getting into tons of detail about the program, I can say that it has worked for a great many people. The challenge, though, is that it is extremely expensive and extremely time-consuming. However, it does tick all the ‘conventional wisdom’ dietary checkboxes (calorie restriction, reduced fat, etc.). We thought an Atkins-like alternative could be just as successful at a fraction of the cost and effort. Our first self-critical question was the risk. You’re always ‘safe’ if you stick with the conventional wisdom. If anything does go wrong (i.e. someone has a major adverse event while on the program) if you’re in with the crowd, you have cover. If you’re not, you’re liable to get picked off, if you know what I mean.

When I recounted this line of reasoning with Dr. Westman, he assured me that he had it covered. Specifically, a major reason why he and his collaborators wrote the book was to decisively report the overwhelming clinical evidence of the effectiveness of this approach and that he and his colleagues had been treating their patients very successfully in their clinical practice for years. Now that I’ve finally gotten through the book, I can report that he did not disappoint.

In some ways, it’s the standard fare: chapters about the principles around which the diet was based, chapters about how to actually implement the diet, meal plans, recipes. But there are two major things that make this book stand out in my mind.

Deconstructs all the potential straw-men

One of the oft-repeated characterization (caricature?) of the Atkins approach is that it’s all about eggs and sausage all the time. While this book is no exception in extolling the virtues of eggs and high-quality, full-fat protein, it explicitly calls out the value of what are referred to as ‘foundation’ vegetables. Simply described as the ‘non-starchy’ vegetables (leafy greens, cruciferous, etc.). These vegetables are part of the plan form day 1 (even in the ‘induction’ phase). They have even included options for vegetarians and vegans. That’s right: a vegetarian Atkins dietary plan – strange bedfellows, indeed.

Overwhelms you with clinical evidence

Just as the doctor stated, the big payoff for me in this book was chapters 13 and 14 which they clearly have targeted to skeptical clinicians. They reiterate all the relevant biochemistry, cite their many successful interventions and buttress their arguments by citing no fewer than 71 publications in peer-reviewed journals that support their approach. Seventy one.

In terms of down-to-earth, practical advice combined with scientific and clinical support for said advice, this book is now at the top of the heap (edging out ‘6-Week Cure’) of books I will recommend to those who want to alter their nutritional practices to benefit their overall health.